Philippines

1.

Background information

The Philippines is an archipelago of 7107 islands located in the western part of the Pacific Ocean off the coast of Southeast Asia. The country has a total land area of 300 000 square kilometres and is one of the largest island groups in the world. Population in the year 2000 was 76.5 million. The annual growth rate for 2000-2005 was estimated at 1.99%. Population projection for the year 2007 was 88.7 million. Accidents consistently remain one of the leading causes of mortality in the Philippines. The Philippine Health Statistics report, for years 1975 to 2002, indicate that there has been an increasing trend in mortality due to accidents per 100 000 population. The mortality rate increased from 19.1/100 000 population in 1975 to 41.9 in 2003. The top five leading causes of death due to injury are assault, transport accidents, accidental drowning and submersion, intentional self-harm and accidental falls. Accidents ranked 8th in 1975, 7th in 1985, 6th in 1995, 5th in 2002, and 4th in 2003 among the 10 leading causes of death. Road traffic accidents constitute the majority of transport accidents. 2. Public policy and legislation

The commitment of the Philippine Government to injury and violence prevention is embodied in its 1987 constitution, which mandates the protection and promotion of the right to health of the people and endeavours to make essential goods, health, and other social services available to all people at an affordable cost. Administrative Order No. 2005-0023 of the Department of Health (DOH) identified Fourmula One for Health as the implementing mechanism for health sector reforms designed to ensure better health outcomes, a more responsive public health System, and more equitable health care financing through critical reform initiatives in the areas of health financing, regulation, service delivery, and governance. DOH similarly issued Administrative Order No. 20060016 on 16 June 2006 establishing the "National Policy and Strategic Framework on Child Injury Prevention" and Administrative Order No. 2007-0010 on 19 March 2007 establishing the more comprehensive "National Policy on Violence and Injury Prevention". National legislation enacted with corresponding implementing rules and regulations that address the issue on injury prevention include the following: (1) Republic Act no .7183, otherwise known as "An act regulating the sale, manufacture, distribution and use of firecrackers and other pyrotechnic devices" enacted 30 January 1992 Republic Act no. 8049, otherwise known as An act regulating hazing and other forms of initiation rites in fraternities, sororities, and organizations and providing penalties therefore" enacted 7 June 1995 Republic Act no. 8505, otherwise known as An act providing assistance and protection for rape victims, establishing for the purpose a rape crisis centre in every province and city, authorizing the appropriation of funds therefore, and for other purposes suggestions Enacted 13 February 1998

(2)

(3)

-2-

(4)

Republic Act no. 8703, otherwise known as "An act requiring the mandatory compliance by motorists of private and public vehicles to use seat belt devises, and requiring vehicle manufacturers to install seatbelt devices in all their manufactured vehicles enacted 5 August 1999. Enforcement of national laws are generally entrusted to the police and the local government

units. 3. National programme development and implementation

The top five leading causes of death due to injury are assault, transport accidents, accidental drowning and submersion, intentional self-harm and accidental falls. Among the 10 leading causes of death, accidents ranked 8th in 1975, 7th in 1985, 6th in 1995, 5th in 2002, and 4th in 2003. Road traffic accidents constitute the majority of transport accidents. A nationwide injury survey in 2003 among children 0-17 years old revealed the following top five causes of mortality: drowning, road traffic accidents, falling, violence, and suicide. Injuries accounted for 11% of deaths. Mortality data primarily come from the Philippine Health Statistics, consolidated annually by the Department of Health. Morbidity data on injury is lacking. Except for some injury-focused reports from the transport, police, and non-government sector, there is a paucity of national surveillance data from non-fatal injury cases. Injury data from hospitals are likewise not currently consolidated nationally. To address the above situation, the Department of Health developed in 2006 a national policy and strategic framework on child injury prevention to guide stakeholders in planning interventions for injury prevention. In 2007, a more comprehensive national violence and injury prevention programme was developed and sought to establish collaborative work among various agencies and sectors to prevent morbidity, mortality, and disability from violence and injuries in all ages. Road traffic crashes are the second leading cause of injury and death for all ages (mortality rate of 7.8/100 000). This is the case even among children 0-17 years (mortality rate of 5.85/100 000). The most vulnerable road user group is the pedestrian followed by the motorcyclists. To address the alarming number of road traffic crashes, the 2004 Philippine Road Safety Action Plan (RSAP) was developed by the inter-agency Road Safety Committee headed by the Department of Transportation and Communication (DOTC). The plan aims to save more than 10,000 lives by halving the anticipated increase in deaths per year and to reduce the death rate (deaths per ten thousand vehicles) by 20 per cent over a five-year period. The Department of Health (DOH) is a member of the National Road Safety Committee. As part of its public advocacy and education efforts, it developed and distributed a drivers health manual which contained advisory messages for the prevention of common diseases and road safety among drivers. Road Safety is No Accident is the theme commonly used in media campaigns. Collaboration with government and nongovernment agencies for various road safety activities was also done. In 2004, it conducted a media launch of the World Report on Road Traffic Prevention and emphasized the need for a systems approach to road safety one that addresses the road, the vehicle, and the user. In April 2007, it spearheaded efforts for the conduct of a massive media campaign to celebrate the first United Nations Global Road Safety Week in collaboration with partner organizations and stakeholders. In September 2007, it organized a motorcycle safety forum to promote road safety among bikers. In December 2007, it conducted training for regional health coordinators on violence and injury prevention.

-3-

In terms of programme planning, it integrated road safety into the comprehensive violence and injury prevention programme which sought to establish collaborative work among various agencies and sectors to prevent morbidity, mortality, and disability from violence and injuries in all age groups. Casualties from traffic accidents have generally remained high over the years. Nevertheless, the number of fatalities has been going down and this may be attributable to several factors, such as the enactment of Republic Act 8750 in 1999 requiring the mandatory use of seatbelts among motorists and the improvement of the capability of health facilities to respond to traffic injuries. A national electronic injury surveillance system (NEISS) is being developed to generate injury-related data from health facilities (primarily hospitals). DOH and partners also continue to advocate for mandatory helmet use among motorcycle riders and to develop policies against drink driving. The goal is to reduce violence and injury rates. The objectives of the national violence and injury prevention programme are as follows: (1) (2) (3) (4) (5) To sustain and strengthen collaboration and partnership among stakeholders To develop a comprehensive communication plan for Violence and Injury Prevention To sustain a nationwide campaign to enforce safety laws To develop and harmonize standards for safety to the basic and essential services for violence and injury prevention To institutionalize a national surveillance system on violence and injury prevention programme

Provincial- and municipal-level local government units implement various initiatives guided by national legislation and policy documents from DOH and other national partners. 4. Coordination, leadership, administration and capacity

The Department of Health is currently organizing a Program Management Committee composed of representatives from government and nongovernment agencies working on injury and violence prevention. A multi-sectoral committee addressing issues on child and adolescent injury and violence was formed in 2006. Assigned within the Department of Health are focal points for violence and injury prevention and road safety, who are in charge of advocacy, coordination, project implementation, health education and promotion. For road safety, a National Road Board was established in 2000 by Republic Act 8794. The law imposes a motor vehicle users tax to ensure the adequate maintenance of national and provincial roads, as well as to promote road safety and minimize air pollution from motor vehicles. The Board is composed of the secretary of the Department of Public Works and Highways (DPWH) as ex-officio head and the secretaries of the Departments of Finance, Budget and Management, and the Transportation and Communications as ex-officio members. Three members come from the transport and motorist groups. DOH is not part of the Board but is a member of the Technical Working Group of the National Road Safety Committee headed by the Department of Transportation and Communications (DOTC). Focal points for violence and injury prevention and road safety in charge primarily of advocacy, coordination, project implementation, and health education and promotion are assigned within the Department of Health. Various nongovernmental organizations contribute to the work on injury and violence prevention. These include the following:

-4-

(1) (2) (3) (4) (5) (6) (7)

Safe Kids Philippines, Inc. Automobile Association of the Philippines Safety Organization of the Philippines, Inc. Philippine National Red Cross Motorcycle Development Participants Association Ford Road Safety Youth Council Project CARES

DOH and other government agencies get their funding from their respective agency budgets. For road safety, road users' taxes collected under RA 8794 are earmarked solely and used exclusively for road maintenance and improvement of road drainage, installation of adequate and efficient traffic lights and road safety devices, as well as for air pollution control. DOH conducted in December 20007 training for regional programme coordinators on violence and injury prevention. 5. Data collection systems

Population-based mortality data is derived annually from the Philippine Health Statistics, which uses ICD codes for diagnoses and external causes. There is, however, a lack of national morbidity data. Except for some injury-focused reports from the transport, police, and nongovernment sector, there is a paucity of national surveillance data from non-fatal injury cases. Current systems of DOH do not include surveillance of injury cases. Injury data from hospitals are likewise not consolidated nationally. A national electronic injury surveillance system (NEISS) is being developed to generate injury-related data from health facilities (e.g. hospitals, rural health units, and barangay health centers). The Department of Health will establish and manage the system in collaboration with partner agencies and organizations. 6. Pre-hospital and hospital care

Trauma care is available in hospitals, both public and private, nationwide. Ambulance service is generally available in all these facilities. Rehabilitation services are available in most tertiary facilities. Referral mechanisms make rehabilitation services available to many victims of injury and violence. 7. Critical issues and challenges in injury and violence prevention Critical issues and challenges include: (1) (2) (3) (4) (5) (6) (7) Resource mobilization to sustain initiatives; Strengthening cooperation and collaboration of key players and stakeholders within the health sector and among various sectors; Strengthening surveillance for violence and injury, to cover both fatal and non-fatal outcomes; Strengthening pre-hospital and hospital care; Building capacity of health managers and key partners; Strengthening enforcement/implementation of legislations and policies on injury and violence prevention; and Strengthening awareness and behaviour of individuals and communities on violence and injury prevention.